title: The efficiency of acoustic radiation force impulse imaging for the staging of liver fibrosis: a meta-analysis.
abstract: OBJECTIVE
  Acoustic radiation force impulse (ARFI) imaging is an ultrasound-based elastography method that is integrated into a conventional ultrasound machine. A meta-analysis based on original and abstract publications was performed to evaluate the overall performance of ARFI for the diagnosis of liver fibrosis.
  
  
  METHODS
  Literature databases and conference abstracts were searched from 2007 up to February 2012. A random effects meta-analysis of the area under the receiver operating characteristic (ROC) curve (AUROC) and the diagnostic odds ratio (DOR) was performed as well as summary ROC curve techniques. Quality analyses were conducted to assess sources of heterogeneity.
  
  
  RESULTS
  The systematic literature search revealed 36 studies, with 3,951 patients overall. The mean diagnostic accuracy of ARFI expressed as the AUROC was 0.84 (DOR, 11.54) for the diagnosis of significant fibrosis (F ≥ 2), 0.89 (DOR, 33.54) for the diagnosis of severe fibrosis (F ≥ 3) and 0.91 (DOR, 45.35) for the diagnosis of liver cirrhosis (F = 4). Subgroup analyses showed sources of heterogeneity between the different underlying liver diseases for F ≥ 3 and F = 4. The mean body mass index had a significant influence for F ≥ 2.
  
  
  CONCLUSIONS
  The meta-analysis revealed good diagnostic accuracy of the ARFI imaging for the staging of F ≥ 2 and F ≥ 3, and excellent diagnostic accuracy for F = 4.
  
  
  CONCLUSIONS
  • Acoustic radiation force impulse (ARFI) imaging adds important information over conventional ultrasound. • ARFI imaging provides good diagnostic performance for assessing significant/severe hepatic fibrosis. • ARFI imaging shows excellent diagnostic accuracy and odds ratio for cirrhosis staging. • Body mass index significantly influences the assessment of significant fibrosis.
authors.affiliation: Institute of Biostatistics and Mathematical Modelling, Faculty of Medicine, J.W. Goethe University, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany, Nierhoff@med.uni-frankfurt.de.
authors.forename: Julia
authors.initials: J
authors.lastname: Nierhoff
authors.forename: Andrea Angelina
authors.initials: AA
authors.lastname: Chávez Ortiz
authors.forename: Eva
authors.initials: E
authors.lastname: Herrmann
authors.forename: Stefan
authors.initials: S
authors.lastname: Zeuzem
authors.forename: Mireen
authors.initials: M
authors.lastname: Friedrich-Rust
mesh_terms: D054459:Elasticity Imaging Techniques / Q000379:methods*; D006801:Humans; D008103:Liver Cirrhosis / Q000000981:diagnostic imaging*; D012720:Severity of Illness Index